Upload
phungcong
View
224
Download
1
Embed Size (px)
Citation preview
Overview of the Polio Country Situation
• global polio situation
• polio in endemic countries
• international spread of polio, 2013 • Horn of Africa
• Middle East
• Central Africa
• current priorities
Polio Cases, last 6 months
Virus concentrated in poor access areas
Substantial new international spread
Horn of Africa Outbreak
Middle East Outbreak
Central Africa Outbreak
Polio-paralyzed children, 2013
0
50
100
150
200
250
300
350
Total Cases Endemic Outbreak
Jan-Oct 2012
Jan-Oct 2013
0
250
500
750
1000
1250
2007 2008 2009 2010 2011 2012 2013
Cas
es
Polio, type 3 cases
Endemic Countries
Endemic Polio Cases, last 6 months
• 50% decline in cases ('12 vs. '13)
• no virus in 3 of 7 'reservoirs'
• no endemic virus in AFG
Polio-paralyzed children
0
20
40
60
80
100
Nigeria Pakistan Afghanistan
Jan-Oct 2012
Jan-Oct 2013
North Waziristan: ban on vaccination
Khyber Agency: military operations
Pakistan 2013
> 500,000 children unreached
with OPV
Peshawar/KP: attacks/intmidation
Pakistan Priorities • area-specific access plans
• transit site vaccination
• religious scholars initiative (with Saudi Arabia)
• elders negotiation
• Pakistan military engagement (with UAE)
• provision of physical security
• operationalize Prime Minister's Cell
Nigeria 2013 30%
36%
60%
18%
37% 37%
63%
79%74%
83% (n=18)
80%
67%60%
80%91% 92% 91% 92%
83%
92% (n=12)
0%10%20%30%40%50%60%70%80%90%
100%
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Prop
orti
on o
f LG
As
Accepted at 80%
Sokoto Zamfara
SNID
results N/A
43%
70%63%
56%
40%50% 50%
60%64% (n=11)
50% 54%
25%
45% 45%
27%36%
45% 43% (n=14)
0%10%20%30%40%50%60%70%80%90%
100%
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Prop
orti
on o
f LG
As
Borno Yobe
71% (n=17)
84% (n=19)
63% (n=16)
78% (n=23)
0%10%20%30%40%50%60%70%80%90%
100%
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Prop
ortio
n of
LGA
s
Accepted at 80%
Kano Jigawa Kaduna KatsinaSN
ID results N
/A
Kano Weak oversight
Programme focus
• LGA (district chairman engagement)
• new tactics: '4 x 4' strategy
• systematic 'pluses'
• multi-pronged comms strat.
Bayo Kwaya- Kusar
Hawul
Shani
Askira/Uba
Chibok
Gwoza Damboa
Biu
Abadam
Gubio
Guzamala
Mobbar Kukawa
Monguno
Marte
Mafa
Magumeri
Nganzai
Kaga
Maiduguri
Jere
Konduga
Dikwa
BAMA
Kala/Balge
Ngala
cVDPV2(n=1)
WPV1(n=16)
No. of inaccessible children, July
0 108,987
Borno Insecurity
International Spread
Highest risk areas 2013
Risk = immunity gap + probability of importation
Reducing Vulnerability
• AFP surveillance (AFP rate >2 at prov/gov level)
• routine immunization/EPI coverage
• early IPV introduction
• OPV campaigns (NIDs or SNIDs)
• vaccination of travellers (per WHO International Travel & Health)
International Spread of Polio
• Afghanistan re-infected • Egypt, Israel, Palestine sewage • Horn of Africa re-infected • Syria re-infected • Cameroon re-infected
Polio, Eastern Mediterranean (EMR)
0
50
100
150
200
250
Jan-Oct 2012 Jan-Oct 2013
Polio Cases
75% of global polio cases
Horn of Africa
Horn of Africa
Polio Outbreak Response 'Zones'
& Zone-Specific
Strategies
(May 2013)
Outbreak/Amplifier Zone: - whole population - short-interval additional dose strategy - 6-8 rounds - 4 month target to stop transmission - IPV (north Kenya)
Historic Spread Zone: - expanded age groups (eg. < 10 years) - 4 rounds - reduce reinfection
Inaccessible Zone: - expanded age groups (eg. < 10 years) - delink to UN/Gov't; transit site/border vaccination - local access negotiation (Red Cres, NGOs, private sect) - Permanent Vaccination Posts (PVPs)
H . E . P r e s i d e n t o f S o m a l i a 1st Lady of Kenya Margaret Kenyatta
Bivalent OPV
Horn of Africa, 2013 Impact to date
May
July
Sept
>500,000 inaccessible
children
OPV Campaigns Conducted & Planned May 2013-March 2014
Enhancing Coverage in Inaccessible Areas
Negotiate access
Govt. & relevant 3rd parties Islamic Advisory Group countries with influence
Engage communities
tailored communications PolioPlus
Adapt tactics & tools
short interval dosing, short duration SIA optimum vaccine mix (mOPV1)
Establish new platforms
transit point vaccination Permanent Polio Teams, NGOs
Strengthen management
dedicated outbreak/area managers optimized staffing
Immediate Priorities, Horn of Africa
• scale-up proven initiatives in south/central Somalia
• continue new access initiatives in south/central Somalia
• sustained OPV campaigns across HoA
• strengthen coordination, Nairobi
Middle East & Syria
Confirmed Polio in Syria
• 10 confirmed cases
• onset Aug - Oct
• probably EGY/PAK origin
• response plan ongoing
Wild Poliovirus in Environmental Samples
Feb - Oct 2013
• found in Israel in May
• historic samples +ve from Feb
• linked to Egypt, Dec 2012
• bOPV response ongoing
• detected in West Bank (Jul, Sept) & Gaza Strip (Aug)
North (n=19) Haifa (n=19)
Central (N=53)
Tel Aviv (n=13)
Ashkelon (n=25)
South (n=102)
West Bank (n=55)
Gaza Strip (n=14)
Jerusalem (n=33)
No.
of s
ampl
es ta
ken
N
o. o
f sam
ples
take
n
No.
of s
ampl
es ta
ken
N
o. o
f sam
ples
take
n
No.
of s
ampl
es ta
ken
No.
of s
ampl
es ta
ken
N
o. o
f sam
ples
take
n
No.
of s
ampl
es ta
ken
N
o. o
f sam
ples
take
n
'Declares the new international spread of
wild poliovirus an emergency for all Eastern
Mediterranean Member States….'
WHO Regional Committee 30 October 2013, Oman
• Oman: US$ 5 million in new funding
• Saudi Arabia: facilitate role of religious scholars
• UAE: scale-up engagement in FATA/Pakistan
• SYR, LEB, JOR, IRQ, EGY, oPT: coordinated outbreak response
Multi-country Response TENTATIVE SIA PLANS – TO BE CONFIRMED
Place Proposed Date
Vaccine Amount <5y
Round 1 Syria 24 Oct tOPV 1.6 m
Round 2 Deir Al Zour 27 Oct tOPV 100,000
Round 2 7 countries by 15 Nov bOPV
tOPV 20 m
Round 3 7 countries by mid Dec bOPV
tOPV 20 m
Optimizing Coverage within Syria
• detailed mapping & engagement with humanitarian actors
• detailed mapping of access, conflict & actors
• actively exploring all options with Govt of Syria & UN system
Middle East Outbreak Operations Management
Amman - multi-country/agency coordination - senior team leader deployed
Damascus - expert team on-site - microplanning/humanitarian pauses
Gaziantep - support to southern Turkey/NGOs
Positive Factors to Limit Int'l Spread
• very strong vaccination culture
• very high coverage before crisis
• pre-planned campaigns for Nov-Dec
• heading into cold/low-transmission season
• very strong leadership, government, UN & humanitarian system support (OCHA, UNHCR, NGOs…)
Cameroon & Central Africa
'Orphan' Poliovirus, Cameroon
• 10 year old child
• fully vaccinated (3 doses)
• date of paralysis 1 Oct 2013
• 'orphan' virus: last seen in Chad nearly 3 years ago
• multi-country investigation & response plans ongoing
CAR? ??
Chad?
Polio Surveillance Sensitivity Cameroon & Surrounding countries
Sample Adequacy Non Polio AFP Rate
< 50% 50 – 79.99%
>= 80% No Data
< 1 1 – 1.99
2 - 3.99 >= 4
Summary
Stop ongoing outbreaks: - Syria - Somalia - Cameroon
Reduce vulnerability: - Middle East - Horn of Africa & Central Africa
Enhance access: Pakistan & Nigeria
Strategic Priorities
DG-led Polio Endgame Mgmt Team
Senior staffing of Amman & Nairobi hubs
15 additional posts in Geneva
Dedicated 'access' unit
Convening IHR Expert Committee
Ongoing WHO Initiatives (ex.)
• absence of Type 3 virus opens the doors to enhanced tools (i.e. mOPV1)
• reinfection in areas of vaccination bans is increasing community demand for OPV
• influential parties increasingly offer to assist with access & negotiations
• fast-track IPV introduction will enhance eradication capacity & reduce vulnerability
Over-riding priority: establish access in all
infected & highest risk areas in advance of
the 2014 low-season.